Inverted left atrial appendage presenting as a left atrial mass after cardiac surgery.

Inversion of the left atrial appendage can masquerade as a new left atrial mass. Failure to be aware of this entity can result in unnecessary diagnostic and therapeutic procedures. If the entity is diagnosed intraoperatively, treatment is simple with external reduction and ligation.

Immunoblastic lymphadenopathy-like T-cell lymphoma displaying rearrangement of both IgH and TCR beta genes after 4-year follow-up of idiopathic eosinophilia.

Immunoblastic lymphadenopathy (IBL)-like T-cell lymphoma (IBL-T) occurred in a 60-year-old female after a 4-year follow-up of idiopathic eosinophilia and upper pharyngeal inflammatory tumor with infiltration of mature eosinophils. Gene analysis of tumor cells revealed rearrangement of both IgH and TCR beta genes. The patient died of lymphoma seven months after the onset of the illness, in spite of chemotherapy against lymphoma. The relationship between eosinophilia and the pathogenesis of IBL-T, as well as the significance of the rearrangement of both IgH and TCR beta genes are discussed.

Deposition of sprayed particles in the nasal cavity.

Therapeutic effects of topically applied steroids is closely related to the deposition of sprayed particles. To clarify deposition in the nasal cavity, model experiments were undertaken using the gas and powder sprays. Deposits on the moistened filter paper which covered the surface of a nose model were assessed by absorbance of the extracts. The influence of the shape and the effect of continuous suction from the posterior outlet were also studied. When the nasal cavity was kept straight without any abnormal protrusions, the gas spray deposited more than 90% of particles. The amount was significantly lowered in the model of a concave septum with hypertrophic turbinates. The powder spray deposited approximately 75% of the original dose. This amount was more than 90% of actually sprayed particles because some loss was inevitable in spraying the powder. In general, the shape of the cavity more affected the deposition of the gas spray than the powder spray. This difference was probably due to the spray angle and to the size and speed of the aerosol particles. It was concluded that the powder spray was preferable to the gas spray with regard to the deposition in the nasal cavity.

Sudden cardiac death during sport and recreational activities in Israel.

Sudden unexpected death of healthy individuals during strenuous physical activity is rarely encountered. In the present study, 36 cases of death during physical exercise over the past 19 years were examined at the Israel National Center of Forensic Medicine. The victims' ages ranged from 13-62 years; none of them had a pre-existing history of a cardio-vascular condition. Atherosclerotic cardiovascular disease (ASCVD) was the cause of death in most of the older participants in sport activities (35 years of age and over), while younger individuals died mainly as a result of diseases of the myocardium. More than half of the deceased had been found fit to participate in active sports following basic medical examination. We conclude that more detailed medical screening tests should be utilized to detect potentially hazardous cardiovascular diseases in all those engaged in strenuous physical activity.

Occupational fatalities in Israel.

Occupational fatal injuries are a worldwide problem. Certain occupations pose a greater risk than others. The purpose of this study was to estimate the death rates from occupational injuries in Israel over a period of 30 months, and to examine the trends in the light of the large numbers of foreign workers who have been brought into the country in the last decade. Two-thirds of the occupational fatalities were in the construction business, mostly owing to falls from a height resulting in death from multiple trauma. About one-third of these victims were foreign workers, even though they comprise only 20% of the work force in this field. Negligible amounts of alcohol were detected in a number of cases. The construction industry is recognized worlwide as a high-risk area claiming many lives each year. The findings in this study suggest that too little attention is given to safety regulations in general, and particularly concerning foreign workers in Israel.

[Cocaine "mules"].

We present 2 cases of "body-packer" syndrome (BPS) in which the "mules" carrying the packages of narcotics arrived at Ben-Gurion Airport presented symptoms of acute cocaine intoxication due to the bursting of packages of narcotics they were transporting within their gastro-intestinal systems. Acute cocaine overdose due to sudden massive release of the drug into the digestive system in BPS, may cause psychosis, convulsions and eventually death. Blood levels of cocaine between 0.25 and 5 mcg/ml are toxic and occasionally lethal. When a package bursts within the digestive tract of a smuggler or blocks the intestines, an immediate laparotomy is necessary to evacuate the "ovules" and the remains of the drug from stomach and intestines. Patients merely suspected of being body packers can be diagnosed by physical examination and by means of various imaging methods. They can be conservatively treated with fluids and mild laxatives and kept under close supervision until the remaining packages are naturally discharged. Sudden onset of psychotic behavior in travelers from South America or other drug-producing countries should raise suspicion of body-packer syndrome. The relevant authorities should therefore be aware of the symptoms and consider their potentially dangerous outcome.

[Fatal rat bites].

We present a rare case of infant death due to blood loss resulting from multiple rat bites. Domestic dogs and cats cause most animal bites. Bites of a house rat usually cause bacterial infection, successfully treated with antibiotics. There is little information about death due to house rat bites. Since the wounds they cause tend to occur post-mortem, they are usually wedged, clean and without subcutaneous bleeding. An 11-week-old, malnourished infant girl was bitten to death while sleeping in her mother's bed in a rat-infested home. The infant's clothing was covered with blood, parts of her face were missing and marks of gnawing were present on her neck and extremities. There was subcutaneous bleeding around the wounds indicating that they were inflicted while the child was alive. Autopsy findings revealed profound blood loss. We conclude that a combination of low socio-economic status, severe failure to thrive, and poor hygiene in a rat-infested environment contributed to the fatal outcome in this attack.

Unconscious influences on a choice of a career: implications for organizational consultation.

The choice of a career is a highly significant and highly complex process that includes all the spheres of a person's life and continues throughout life. Psychodynamic theory makes a significant contribution to current models of career counseling and organizational consultation by adding the dimension of unconscious career choice. The unconscious determinants of vocational choice are internalized "objects" and "object relations" that reflect the individual's personal and familial history. People choose an occupation that enables them to replicate significant childhood experiences, fulfill needs that were unfulfilled in their childhood or actualize occupational dreams, professional patterns and expectations passed on to them by the familial heritage. The addition of the component of unconscious selection is critical to the full understanding of career choices and the prediction of success and satisfaction in that career. An example that demonstrates this point is presented.

Relationship between idiopathic peripheral facial paralysis and climate.

We attempted to analyse a relationship between idiopathic peripheral facial paralysis and climate. One hundred and thirty-seven patients, 76 female and 61 male, were studied. The occurrence was not correlated with the mean temperature, mean humidity or mean atmospheric pressure. It can be assumed that unfavorable weather conditions, i.e. a wide temperature range, a lower percentage of sunshine and cloudy days, may bring on idiopathic peripheral facial paralysis.

Breast hamartomas: clinicopathological and immunohistochemical studies of 24 cases.

AIMS: The aim of our study was to investigate the clinical, pathological and immunohistochemical features of breast hamartomas, in order to obtain a detailed profile of this somewhat uncommon lesion. METHODS AND RESULTS: This study presents a clinical, pathological and immunohistochemical analysis of 24 breast hamartomas. Four cases of fibrocystic breast changes were used as a control group. The immunohistochemical panel induced oestrogen (ER) and progesterone (PR) receptors, c-erbB-2 protein, p53, Ki67, CK-MNF116, and vimentin. The patients ranged in age from 30 to 78 years (mean 48 years). All patients presented with a palpable unilateral mass. Three patients showed two hamartomas in the same breast. Tumours ranged from 20 to 50 mm in diameter. Typical macroscopic and microscopic features were noted. Immunohistochemical studies showed ER and PR receptor positivity in epithelial cells as well as in the stromal cells in all 24 cases. No c-erbB-2 protein over-expression was noted. p53 expression was not observed. Ki67 showed 2-3% positivity in epithelial cells and not in stromal cells in most cases. CONCLUSIONS: There was no association with side, ethnic origin or dietary habits. The immunohistochemistry of hamartomas is generally similar to normal breast or fibrocystic breast tissue. Ki67 together with receptor positivity may reflect some proliferative activity and explain observed faster growth of hamartoma during pregnancy and lactation.

Cytotoxic phenotype of intra-epithelial lymphocytes in normal and cryptorchid human testicular excurrent ducts.

BACKGROUND: Most testicular and epididymal lymphocytes express T-cell markers, but their cytotoxic potential and activation status have not been reported. In this study, distribution of the cytotoxic cells was compared between normal and cryptorchid testes stratified into two groups: the first with complete absence of germ cells [Sertoli cell-only (SCO)] and the second with arrested spermatogenesis (SCA). METHODS: Immunohistochemistry for the T-lymphocyte marker CD3 and cytotoxic markers CD8, TIA-1 and granzyme B was performed on paraffin-embedded sections. RESULTS: The number of CD8+ and CD3+ intra-epithelial lymphocytes (IELs) increased distally throughout the normal epididymis. TIA-1 immunostaining revealed that a significant proportion of IELs exhibited cytotoxic potential, whereas granzyme B staining disclosed a subpopulation of activated cytotoxic lymphocytes (CTLs). TIA-1/CD8 and granzyme B/CD8 double immunostaining revealed that the vast majority of TIA-1+ and granzyme B+ cells were CD8+. The proportion of activated granzyme B+ lymphocytes increased distally throughout the normal epididymis. The number of TIA-1+ and granzyme B+ intra-epithelial and stromal lymphocytes was significantly increased in the normal as opposed to the SCO cryptorchid epididymis and proximal vas deferens. CONCLUSIONS: These results suggest that exposure of the testicular excurrent ducts to spermatozoa or immature germ cells triggers the activation and recruitment of CTLs. Cytotoxic granule effector mechanisms may contribute to the immunological barrier preventing the immune response to spermatozoa in testicular ducts.